Cardiology Flashcards
What causes a fourth heart sound?
When the atria pump blood into a non-compliant or hypertrophied ventricle - the ventricles cannot expand further thus producing the fourth heart sound. This will be low pitched. It will be heard just before ventricular systole (just before S1) A FOURTH HEART SOUND IS ALWAYS ABNORMAL
What causes a fourth heart sound?
When the atria pump blood into a non-compliant or hypertrophied ventricle - the ventricles cannot expand further thus producing the fourth heart sound. This will be low pitched. It will be heard just before ventricular systole (just before S1) A FOURTH HEART SOUND IS ALWAYS ABNORMAL
Which coronary vessel supplies the inferior aspect of the heart?
Right coronary artery
What lifestyle modification recommendations should be made to patients following ACS?
- Stop smoking
- Mediterranean style lifestyle
- Lose weight
- Regular exercise
- Regular GP appointments to check bloods
- Keep alcohol consumption moderate
Which four medications is a patient likely to be started on prior to discharge following an myocardial infarction?
- Statin
- Aspirin
- Ace-inhibitor
- Beta blocker
(+Clopidogrel for 12 months if NSTEMI)
What are the risk factors for ACS/coronary vessel occlusion?
- Smoking
- Family history
- Diabetes
- Age
- Hypercholesterolaemia
- Hypertension
- Ethnicity
- Male
- Obesity
What are some causes of a fourth heart sound?
-Heart failure -MI -Cardiomyopathy -Hypertension (myocardium thickens inwards so you won’t find a displaced apex beat)
What are causes of a third heart sound?
Normal in children and young adults up to 30 years A ventricular sound, as blood rushes in during the rapid filling phase of early diastole (right after ventricles have emptied) Heard just after S2 (this is when the ventricles are refilling rapidly) Stiff or dilated ventricles suddenly reaches its elastic limit and decelerates the incoming rush of blood Causes: -Heart failure -MI -Cardiomyopathy -Hypertension (pressure overload) -Mitral and aortic regurgitation (due to volume overload) -Constrictive pericarditis
What are some causes of a fourth heart sound?
-Heart failure -MI -Cardiomyopathy -Hypertension (myocardium thickens inwards so you won’t find a displaced apex beat)
What are causes of a third heart sound?
Normal in children and young adults up to 30 years A ventricular sound, as blood rushes in during the rapid filling phase of early diastole (right after ventricles have emptied) Heard just after S2 (this is when the ventricles are refilling rapidly) Stiff or dilated ventricles suddenly reaches its elastic limit and decelerates the incoming rush of blood Causes: -Heart failure -MI -Cardiomyopathy -Hypertension (pressure overload) -Mitral and aortic regurgitation (due to volume overload) -Constrictive pericarditis
What are two important investigations to do in the long term following a STEMI?
Exercise tolerance test (ETT)
Echocardiogram
After administering thrombolysis for a STEMI, what would you expect to see in the leads if it was successful?
Decreased ST elevation of 50%
If thrombolysis for an MI was unsuccessful, what two further options do you have?
Further thrombolysis
Percutaneous Coronary Intervention (PCI)
What are the auscultatory features of mitral regurgitation?
- Pansystolic murmur
- Consistent volume
- Radiating to axilla (Due to the location of the mitral valve, any sound it produces (whether from regurg or stenosis) will radiate to the axilla
Which aspects of the heart do the following vessels supple?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery
-
Left anterior descending artery
- Anterior sepum
- Anterior wall
- Apex
-
Left circumflex artery
- Lateral wall
-
Right coronary artery
- Posterior, lateral and inferior segments of the heart
Say a patient presents with a STEMI and you want to give thrombolysis. What are the contraindications to thrombolytic therapy?
- Intracranial haemorrhage
- Stroke within past 3 months
- Head injury within past 3 months
- Brain tumours
- Pregnancy
- Severe HTN
- Major surgery within past 3 weeks
- Internal bleeding within past 2-4 weeks
- Active peptic ulcer disease
- Trauma
What is the single most important investigation that must be done in every single patient presenting with chest pain?
Echocardiogram (ECG)
Describe the 4 steps of antihypertensive ladder for a 60 year old caucasian lady
- She should be started on a CCB or diuretic.
- If this doesn’t control the HTN, then try adding an ACEi
- If this still doesn’t control the BP, add a CCB or diuretic (whichever one you didn’t choose in the first step
- Beta blockers
Why do ACE inhibitors cause a cough?
Thy cause a build up or bradykin, which cause cough (and oedmea, beward of life threatening oedema in hereditary angiodema patients - avoid ACEi)
If a patient cannot tolerate an ACE inhibitor due to cough, what would your next step be?
Switch to an ARB
What are some common reasons for secondary hypertension?
- Glomerular disease
- Renal artery stenosis
- COCP
- Coarctation of the aorta
- Diabetes
- Cushing’s disease
- Pregnancy
- Conn’s syndrome (Primary hyperaldosteronism)
- Phaeochromocytopa
What are the two types of valve replacement and name the main pro and con for each
-
Metallic valve
- Lifetime warfarin required
- Longer life
-
Tissue valve graft
- Shorter life (10-15 years)
- Warfarin only needed for 6 months
A young woman who still wants to have children asks why you recommend she does not get a metallic valve.
Please explain to her why you would not recommend it?
Metallic valve replacment required lifetime warfarin therapy. Warfarin is teratogenic and would therefore not be suitable.
What are your treatment options for someone presenting with a raised INR?
- Phytomendione (Vitamin K1)
- FFP
- Prothrombin complex (Factors II,VII,IX,X)
